Posts by swiftbear86

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mistyowl11 said:Does anyone in Washington, D.C. know a good physical therapist or even just someone who specializes in chronic pelvic pain? I'm dealing with some serious tension in my lower pelvic muscles and could really use a professional recommendation.

Based on my own experience, I really can't recommend this enough: make sure you schedule that first consultation—and go for the super thorough one—around... $50Standard rates apply for all treatments.

gentlecrane31 said:No, the B-list used to cover the supplemental cost of $26 that I would have normally dealt with under the A-list. Since the United States unilaterally canceled my supplemental insurance policy, I don't have that coverage anymore. So, I'm stuck paying the full retail price just like anyone else without extra insurance—Medicare just picks up whatever is left. This specific medication usually goes for about $233 when it's just sitting on the shelf in retail stores.

When people talk about the "full price" of a drug, they mean what you pay via a private prescription if you don't have health insurance, or if the drug isn't covered by Medicare, or if your specific diagnosis doesn't meet the Medicare guidelines for Plan A or Plan B.

Since a "copay" implies the drug is on the supplemental list (Plan B), I'm a little confused by what you wrote in bold above.

The primary list consists of basic medications that don't require a copay because Medicare covers the entire amount.
The full price of the medicine is $233, just like you mentioned.
If your supplemental policy was canceled, you basically paid $3.25 for the standard copay plus the extra cost for a Plan B drug. So, technically, you didn't pay the full retail price of the drug, you just paid the supplemental copay.

We really need to nail down these definitions so there isn't any confusion.

Full price = the drug isn't covered by Medicare at all.
Copay = $3.25 what you pay per prescription regardless of whether it's on List A or B, assuming you don't have supplemental insurance.
Supplemental cost = the amount Medicare sets for drugs on the supplemental list (Plan B).

Anyway, it feels like Cisco is acting like they couldn't care less, so now Allstate sees an opportunity to step in. I wonder how long they'll actually keep offering that Plan B coverage, but honestly, it doesn't matter to me—I've already signed up with them.😁

I think there might be some confusion here🤔.
How exactly did you end up paying the full retail price for the medication?

With an Aetna supplemental plan that includes a B-list, you should have been covered for $3.25 both the copayments and the out-of-pocket costs for drugs on that specific list. If you paid the full sticker price, it sounds like the drug wasn't listed on either tier.
Take a quick look at your pharmacy receipt to see the exact breakdown. It usually lists the full price first, followed by any adjustments, then the copay, the tax, and finally the amount being billed to Medicare.

They definitely should have reached out to let you know one way or another.

Here’s how I see it—an insurance year is just a 12-month cycle starting from whenever your coverage kicked in. You mentioned your card shows an expiration around the 6th or 7th month of the year, which basically means once that date hits, a brand new policy year starts up. Usually, unless you explicitly ask to cancel, everything just rolls over automatically. If you actually want to end the coverage, you've got to give them a heads-up in writing ahead of time. Honestly, Cisco made things unnecessarily messy this year; at the slightest hint that the government might hike up supplemental rates (which didn't even happen), they started blasting out notices saying prices were going up and they were cutting certain coverage tiers.
I don't get why they'd even send you a bill if you haven't signed off on anything.
My cousin didn't bother sending back his signed notice, and he's still getting billed at the old rate. The big question is whether he’ll run into the same headache next month when he's standing at the pharmacy counter facing a massive out-of-pocket cost for his meds.

From what I’ve gathered, Cisco doesn't even offer those B-list policies anymore.

Back in May or June, most people were getting notices in the mail. They were citing some new law that hasn't even actually passed yet, basically telling everyone they needed to either sign off on a policy for $30 (which leaves out the B-list stuff) or just cancel their coverage entirely.
I’m honestly not sure what happens if you just ignore the notice and don't send anything back.
I never got a notice myself, and since my policy is expiring soon, I'm not planning on renewing with Cisco anyway. Allstate offers the B-list option, though they do have age limits based on how old you are.
I know a few people who got the notice but didn't bother sending back their consent for $30, and nothing has happened to them so far—maybe it's just because we're in the middle of the new insurance year.

If your policy runs through July 2017, did they just let it lapse once the new year kicked in?🤔

I heard this only applies to people looking to sign up for a new policy. Apparently, if you've already signed your contract, the current terms stay in place until your coverage actually expires.

Samuel Davis3 said:Here is a perfect example of how we get ripped off at local pharmacies. I honestly cannot believe the margins they are pulling. Twinlab products are a prime example of where they just bleed you dry. My parents aren't really used to ordering things online (except when I do it for them), and I lost my mind the other day when they bought this without checking with me first:

https://www.dropbox.com/s/xlifvqczl2...72838.jpg?dl=0

Basically, the price for these Omega fatty acids is $83 for a 90-capsule bottle.

Now look at this identical packaging: http://bit.ly/1Y0i49a

That only costs $14 (plus $4 for shipping), making it $18 total, which comes out to $40. I assume people would grab a few more items so the shipping fee becomes negligible.

How on earth can the difference be double???
This is just one instance; sometimes the gaps are way, way larger.
Go ahead, be a fool and keep buying from the pharmacy if you want.

Based on what you said, we still don't actually know what kind of markup you think an American pharmacy is running, right?
And why on earth would you expect a price at a local pharmacy here in the US to be identical to some random website overseas?

Plus, there are times when a manufacturer or a distributor decides to cut back their margins for the US market, which means you might find a better deal through certain domestic online pharmacies.

Don't forget you've got to account for that 25% sales tax, too.😁
And look, free advice is always available—as long as you're willing to talk to a pharmacist instead of just avoiding them.😁

This topic is pretty old and only has three posts in it. I’m sure everyone here has gained way more experience since then, so please, share what you know.
Has anyone on this forum visited the Mayo Clinic outpatient clinic to try acupuncture for pain management? I'd love to hear about your results. If there's already a similar thread going, please feel free to move this one.

Richard Moore53 said:So, does this mean once I hit my 60s, I’ll be forced to jump onto a much more expensive insurance plan?

Sent from my Samsung Galaxy using Reddit

You can actually find a whole FAQ section right on the CDC website here:

A client signed up for a Deloitte policy at age 59, including the B-list coverage. Will the premium automatically jump to a higher rate (currently $50) when they enter the calendar year where they turn 61?
In this scenario, the client keeps paying the specific rate they originally locked in, $32 until the policy term actually expires.

All set.

melloworca6 said:That’s great. 👍 I really don't think you'll run into any issues when you go to pick it up.

That's exactly my point—I honestly have no clue if things still work that way. My experience was from a few years ago, and let's face it, they seem to come up with new bureaucratic headaches every single year. 🙂

Do they not print private prescriptions over there? Every time I need Quensyl, I have to trek all the way to my doctor just to get them to print out a script, slap a stamp on it, and sign it. Only then can I head to the pharmacy and actually order the medication. I wish I could just call it in and have them send it straight to the pharmacy, but I guess since it's an imported drug, that's not an option. As it stands, I end up making a trip just for the paper, and I usually end up catching some bug in the waiting room while I'm at it. 🤦

They do print private ones; I meant the prescriptions covered by Medicare.😉
Sometimes they'll do it, but only if the pharmacy doesn't have any other way to process it.😵

melloworca6 said:I’m not entirely sure how the system works nowadays because the last time I lost my Synthroid prescription a few years back, there was this weird glitch in the software. My sister actually showed me on her computer screen. She couldn't print prescriptions before a certain timeframe; if she tried, it would just spit out blank pages and flash an error in the system. I saw it happen with my eyes when she tried to print that Synthroid earlier.

The doctor could technically approve them—they were sort of manual overrides—but I think the catch was that Medicare had set limits on how many of those they were allowed to issue.

Honestly, I feel for them. They’re stuck between a rock and a hard place. You have to find that sweet spot where you aren't leaving patients hanging, but you also aren't dealing with Medicare breathing down your neck with fines, threats of losing your license, and all sorts of other headaches.

These days, they don't even print them anymore since everything is electronic.
I often see cases where a new prescription has been issued, but the patient is still holding onto an old one that hasn't expired yet.
That said, not every doctor uses the exact same software, so there might be instances where it works for some and fails for others.

melloworca6 said:So, here's what happened to me once: I lost my bottle of Synthroid (it's the same medication you're taking, just a different brand) and went to see my doctor. I told her I'd misplaced the whole thing and was completely out of pills, and she just wrote me a new prescription without any hassle at all.

Obviously, they aren't going to keep writing them if you're losing your meds every other week, but if it happens once in a blue moon, I don't see why it should be an issue.

The real issue is that some doctors can be pretty difficult. They’ll make patients wait until they're down to their last seven pills, even though it's totally possible to write double prescriptions or issue a new one when the patient still has a recurring prescription from a few months back. From what I can tell, there isn't some software glitch stopping them; it really just comes down to whether the doctor decides to help you out (or the nurse, who usually just clicks through whatever is already in the system).

Honestly, I really have no clue how a doctor's office software actually handles all those calculations—I don't work behind the desk at a clinic.

boldlynx7 said:Could use a little help here.
I lost my TyraQ pill pack🤦. There were 25 tablets in it, and I'm wondering if it’ll be an issue to order more. From what I can see, you can only request a refill seven days early—though I might have ordered sooner once before because I take a "weird" dose. I mix whole pills and halves, swapping them around to get the right amount when I need a half dose.
I want to know how they track prescription refills—does it count from the date the last one was issued, or does everything just "accumulate" together?
Thanks

Prescription refills are calculated based on the actual date they were issued (not quite sure what you mean by the second part of your question).
Basically, you can get a new prescription after 100 days, adjusted for how much you actually use.
If your doctor tells you they can't write a new script yet, ask them to write you a private one instead so you can just buy a single box. Or, just head down to the pharmacy where you usually pick up your meds, explain the situation, and ask if you can just purchase a box there.

Honestly, I’m a little lost on what you’re actually asking me.
Medical leave basically wraps up when you tell your doctor you're ready to get back to work. That's when they issue the pay stub documentation. These slips have to align with the calendar month. So, if you're out on sick leave from January 28th through February 10th, you’ll end up handing your employer one slip for January and another one for February.
Just so you know, notifying your boss that you'll be out for two weeks isn't a legal requirement; you can always decide to head back sooner, and the doctor only writes up the paperwork once you've actually made that call.
As far as I understand, the pay stub itself doesn't list your employer—Medicare already has all the details on who your employer is and who's paying your payroll taxes.

Jamie Garcia7 said:One more thing—what kind of tests do they usually ask for before going under general anesthesia? Are we talking stress tests, a full physical, or just an EKG?

And even more importantly, how old can those results be? Is a week okay? Two weeks? A month? I know this might have popped up somewhere in the corners of this thread, but I’d really appreciate a straight answer. I'm sure anyone else browsing here will find this info just as vital.

The consultation with the anesthesiologist is the most important part, and that presentation above basically just outlines the prep steps.

Since we don't know the specifics (you mentioned some gynecological issues), you should probably just check your Medicare benefit statement and judge for yourself. They don't list specific diagnostic codes, but they do show the general reason why you're out on medical leave.
Generally speaking, those statements give you enough info to see the core issue behind your sick leave.
http://cdn.medicare.gov/wp-content/upload...a_29012015.pdf

Rebecca Chase62 said:Here’s my dilemma: my physiatrist prescribed therapy for both sciatica and heel pain. The issue is that my primary care doctor wrote just one referral covering both diagnoses, but the folks over at the Mayo Clinic are telling me I need a separate referral for every single diagnosis to get physical therapy.
So, who's actually right here?!

Honestly, nobody really knows for sure. 😁
I have a feeling those people at the Mayo Clinic are being a bit difficult.

Take my situation from a month ago (not involving Božid)—I needed PT for several different issues. My physiatrist covered everything under a single referral based on my diagnoses, claiming Medicare follows that logic. If we went by the other theory, some people would need five different referrals, or they'd be stuck running back and forth all year just to treat different parts of their bodies.😁
It really boils down to the physiatrist. Did you see your specialist at the Mayo Clinic or somewhere else?
If you really want to fight tooth and nail about it, you could always send an inquiry straight to Medicare.😉